Case Study: Preamble: Josephine Attributes Her Eating Disorder

PREAMBLE: Josephine attributes her eating disorder to dislike for the unhealthy food that her mother prepares and to her job as salsa instructor that demands that she regulates her weight. She sometimes eats only one meal per day, forcing herself to, occasionally, vomit when she eats too much junk or fried food and is overly concerned with her weight level and diet. Whilst on no medication, she occasionally takes multivitamins and is trying to reduce her weight of 117 pounds to her former count of 110 pounds.

Based on her height and weight, what is her BMI and is this considered underweight, normal or overweight/obese?

Her BMI (weight: 117 pounds; height 5 feet 2 inches is 21.4. She is actually in the middle range of normal weight. Underweight is less than 18.5; normal weight is 18.5-24.9, whilst overweight ranges between 25 -- 29.9. Obesity consists of a BMI of 30 or greater (U.S. Dpt of Health and Human Services; National Heart Lung and Blood Institute).

Based on her above food record, what are some areas you can see that needs to be improved?

Josephine has to eat a healthy breakfast optimally consisting of cereal -- a healthy brand that preferably contains bran, which is a carbohydrate product. Benton and Parker (1998) found that breakfast consumption improved memory performance on three tests and that even relatively low glycogemic index rates (produced from slow-intaking carbohydrates) had a positive impact on memory enhancement. Breakfast is important to the extent that studies have consistently found that breakfast has been found to positively influence declarative memory (e.g. recall for stories and word lists).

Gibson, for instance, has shown that the type of carbohydrate that one consumes is more important than the amount that one consumes and that a small amount of carbohydrate can improve memory functions on standardised laboratory tests (Benton & Parker, 1998). Gibson also discovered that the best memory boosters were foods that contained a high GI value -- in his case, 'All-bran' whereas high GI value carbohydrates such as coco-pops, had a lower performance effect, (although. The effect was still greater than those who had none whatsoever) (Lovett, 2007).

The breakfast then needs to be totally altered with the fried beans and rice cut out. In fact, fried food is a no-no. Lunch seems fine with carbohydrate, protein, and vegetables nicely balanced. It may be a bit too meagre for Josephine's needs. Also considering that Josephine is actively involved in exercise for a good proportion of her day, she may need more food to boost her strength.

The lunch seems top-heavy on the protein with too little carbohydrate and vegetables included. One turkey slice should be sufficient, whilst Josephine -- needing more calories due to her exercising, should consume more carbohydrates and vegetables.

Dinner again needs to be modified with the top-heavy carbohydrate lessened somewhat (one tortilla may be sufficient) and with the fried food eliminated. Otherwise, the whole shows a balanced regulation of carbohydrate, protein, and vegetable.

Josephine may want to consider having the least heavy meal before bedtime since some researchers consider it best that the heavy meal be in the middle of the day rather than towards the end.

I also notice that there is no milk or milk-products in Josephine's diet. Josephine would do well to incorporate that, as well as to include greater portions of fish in her eating plan. Fish is considered a specifically healthy addition.

Other areas to investigate are the fibre of the rice and tortillas that Josephine consumes -- whether they are whole grains, whether the skin has been removed of her turkey and whether her turkey is low-fat. Moreover, I would also consider whether the fruits and vegetables are fresh; the quality of the tortilla and chicken / meat; the sodium level in the beans, and the quality of the food altogether. I would also recommend inclusion of eggs and nuts, as well as periodic healthy snacks during her day. This would eliminate her need for junk foods.

Josephine seems to control her portion sizes, although her biography indicates that she fluctuates. I would recommend her to be more consistent as well as to ensure that her meals remain low in saturated fats, trans fat, cholesterol, sodium, and sugars.

Josephine does not need to lose weight. On the contrary, she exercises regularly and therefore an eating plan that contains 1,200-1,600 calories per day would be suitable for her needs.

Also important is the fact that Josephine sticks to a regular diet of 3 meals per day with intermittent health snacks and drink more water.

3. What lab values are elevated or decreased and what are some reasons for these high or low values?

Her sodium value is elevated. This is due to the fried food and likely inordinate amount of salt that her mother uses in food preparation. A high sodium level is deleterious for blood pressure and the Dash diet established by the Dietary Guidelines for Americans (2005) recommend reducing sodium intake in order to stop hypertension. The sodium recommendation made by the Federal Government's National High Blood Pressure Education Program is less than 2400 mg per day, whilst the Dietary Guidelines suggest 2, 300 mg daily (that is less than 1 tsp.) (Health Castle.com). Her iron level, on the other hand, is low. Iron is a key dietary nutrient that is indispensable for the healthy functioning of her body. Not only doe sit help burn fats but also facilitates the smooth transportation of oxygen to the blood cells as well as being important for healthy muscle functioning. Josephine needs to consume more foods that are high in iron. She already has beef, but needs to include fish, seafood, seeds, and nuts in her diet, as well as milk and milk-based products. Josephine also needs to introduce pastas, lentils, peas, and dark leafy vegetables. Eggs are important too.

As per her sodium level, I would investigate the packaged and canned food that her mother includes in her diet, as well as reducing the amount of beef and turkey consumed all of which are processed foods high in sodium. I would recommend that Josephine choose fresh or frozen vegetables and beans instead of canned; that she choose fresh meats instead of cured meats; and that if she has to have canned foods she should rinse and drain them whenever possible.

Additionally, she should look out for any form of the word 'sodium' that is part of ingredients. Derivatives include sodium chloride, sodium citrate, sodium bicarbonate and so forth and are usually found on packaged food.

4. What nutrition recommendations would you provide her? Specifically, how many calories, carbohydrates, proteins and fats would you provide her?

Josephine does not need to lose weight. On the contrary, she exercises regularly and therefore an eating plan that contains 1,200-1,600 calories per day would be suitable for her needs.

According to the Mayo Clinic prescriptions, I would recommend that Josephine get 45 to 65% of daily calories from carbohydrates. Since carbohydrates have 4 calories a gram, this would amount to 900 to 1,300 calories a day. She should focus on natural, nutrient-dense carbohydrates from fruits and vegetables, beans, and legumes and from whole grains. She should opt for whole-wheat tortillas and rice rather than refined grain products.

The Mayo Clinic further recommends that Josephine receive 10 to 35% of her total daily calories from protein. Since protein has 4 calories a gram, this amounts to about 200 or 700 calories a day. Protein that Josephine should focus on would include beans, lentils, soy products, and unsalted nuts. She should include seafood twice a weak. Her meat, poultry, and dairy products should be low fat.